POS0366 MODERATE RATES OF TREATMENT INTENSIFICATION IN SLE PATIENTS WITH RESIDUAL DISEASE ACTIVITY
Authors: O. Gioti, M. Nikoloudaki, K. Chavatza, E. Kalavri, A. Elezoglou, P. Sidiropoulos, G. Bertsias, D. Boumpas, A. Fanouriakis
Journal: Annals of the Rheumatic Diseases (2022)

Background The treat-to-target (T2T) strategy has gained significant attention in SLE, 1 while EULAR has set remission or low disease activity as the goal of treatment. 2 Nevertheless, the degree to which T2T is followed in real-life clinical settings has not been extensively studied. Objectives To assess the proportion of lupus patients with residual disease activity that had their therapy intensified during their most recent visit, identify associated factors, and assess the validity of the SLEDAI-2k as a predictor of this intensification. Methods Cross-sectional study of SLE patients who were evaluated in three tertiary centers in Greece during their last visit. Patients were categorized in four disease activity states (remission on and off treatment, low disease activity and non-optimally controlled), according to definitions used in previous studies. 3 Intensification of treatment was defined as addition/increase of glucocorticoids (GC) or addition/increase of immunosuppressive (IS) agent (conventional or biologic). Logistic regression analysis was used to identify factors associated with treatment intensification and ROC analysis tο calculate sensitivity, specificity of different SLEDAI-2k cut-off values to predict this escalation. Results 332 patients were included [93.1% female, mean (SD) age 48.5 (14.7) years, median (IQR) disease duration 6.5 (12.4) years]. Regarding disease activity states, 23.2% (n=77) of patients were in remission (off or on therapy), 36.7% (n=122) were in LDA, while 40.1% (n=133) were categorized as non-optimally controlled disease. Within patients with residual disease activity, therapy intensification was offered to 25.8% and 48.9% of those with low disease activity and non-optimally controlled disease, respectively. In multivariable analysis, proteinuria (OR 6.78, 95% CI 2.06 – 22.25), arthritis (OR 5.48, 95% CI 3.20 - 9.40) and rash (OR 3.23, 95% CI 1.81 - 5.75), were associated with intensification of therapy. The AUC of the ROC analysis for total SLEDAI-2k to predict therapy escalation was 0.761, indicating only fair accuracy; the cut-off value with the best combination of sensitivity and specificity was 3 (sensitivity 87%, with a specificity of 55%). For clinical SLEDAI-2k, the respective AUC was marginally better (0.779), with a cut-off of 3 being associated with the best sensitivity (80%), with compromised specificity (64%). (Figure 1). Figure 1. ROC analysis of total and clinical SLEDAI to predict any increase in therapy Conclusion In real-life clinical settings, no therapy intensification was offered in more than half of patients categorized as non-optimally controlled disease. Total and clinical SLEDAI-2k showed only fair accuracy to predict therapy escalation, reflecting the role of additional parameters in the decision to escalate therapy in an individual patient. References [1]van Vollenhoven RF, Mosca M, Bertsias G, et al. Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 2014; 73: 958–967. [2]Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 736–745. [3]Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al. Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis 2017; 76: 2071–2074. Disclosure of Interests None declared